Healthcare Provider Details

I. General information

NPI: 1164615209
Provider Name (Legal Business Name): GRAMMY'S HOUSE ARTESIA DOMESTIC VIOLENCE SHELTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W TEXAS AVE
ARTESIA NM
88210-1968
US

IV. Provider business mailing address

811 W TEXAS AVE
ARTESIA NM
88210-1968
US

V. Phone/Fax

Practice location:
  • Phone: 505-748-1198
  • Fax: 505-748-7334
Mailing address:
  • Phone: 505-748-1198
  • Fax: 505-748-7334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number1654490
License Number StateND

VIII. Authorized Official

Name: MRS. NANCY HUSSELMAN
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential:
Phone: 505-748-1198